3. METODOLOGÍA
3.3. CARACTERIZACIÓN DEL ESCENARIO DE RIESGO
3.3.3. Riesgo
bodies to counteract obesity and improve health equity.: EuroHealthNet; 2010. 8) Available at:http://www.emro.who.int/cbi/cbi_introduction.htm
9) Bogers RP, Barte JCM, Schipper CMA, Vijgen SMC, Hollander de EL, Tariq L, Milder IEJ, Bemelmans WJE. Relationship between costs of lifestyle interventions and weight loss in overweight adults. Obes Reviews, 2009;37(4):270-7.
10) Brug J, van Dale D, Lanting L, Kremers S, Veenhof C, Leurs M, van Yperen T, Kok G. Towards evidence-based, quality-controlled health promotion: the Dutch recognition system for health promotion interventions. Health Educ Res. 2010 Dec;25(6):1100-6. Epub 2010 Sep 13. 11) Good practice appraisal tool for obesity prevention programmes, projects, initiatives and
interventions. WHO/EC Project on monitoring progress on improving nutrition and physical activity and preventing obesity in the European Union. World Health Organization, Regional Office for Europe, 2011.
Disclaimer
The views expressed in this document are those of the authors and do not necessarily reflect the official position of the European Commission. Neither the Commission nor any person acting on its behalf can be held responsible for any use that may be made of the information in this document.
Annexes
1 WHO definition of community-based initiatives and inclusion criteria for this survey
2 Questions of short questionnaire
3 Inventory of existing sources which were screened for potentially suitable CBIs
4 List of potentially suitable projects
5 Items included in the electronic questionnaire and justification
6 Microsoft Word version of CBI questionnaire
7 Methodology for rough estimation of the total number CBIs in Europe
8 List of CBIs: cities and potential target population
9 List of CBIs: reach of activities
10 List of CBIs: information on quality indicators
11 List of references provided by the CBI respondents related to theoretical basis and existing evidence
12 Effectiveness
ANNEX 1 -
WHO definition of community-based initiatives and inclusion criteria for this survey
The WHO definition (www.emro.who.int/cbi/cbi_introduction.htm) :
Community-based initiatives (CBI) adopt a holistic approach to health paying equal significance to the physical, mental, social and spiritual well-being of individuals. CBI programmes represent integrated bottom- up socioeconomic development models that rely on full community ownership and intersectoral collaboration.
Inclusion criteria for this survey:
1. The CBI should have a health objective involving prevention of obesity targeting nutrition and/or physical activity (please note that also interventions started from a disease prevention perspective (for example diabetes prevention) can be eligible for inclusion; since these projects generally target lifestyle behaviour with expected effects on overweight prevention))
2. The target population should include children aged 0 through 16 years (e.g. children 0-16, 5-10, 12-15).
3. The CBI should be implemented in the period 2005 through 2011 4. The CBI activities should have a (planned) duration of at least 1 year
5. Intersectoral collaboration of at least two different stakeholders1 representing society partners should be an element of the CBI approach.
This means that for the intervention at least one of the following options has to apply: a. More than one policy area (such as finance, justice, environment, education) provides (political) support to the intervention as is clearly defined in a policy document, and/or;
b. There is a financial structure in which at least two society partners (stakeholders1) are providing funds, and/or;
c. At least two stakeholders1 from different settings collaborate. This entails
collaboration between the primary setting (i.e. the setting where most activities of an intervention are organized) and another setting within the community. An example that meets this criterion is a school based approach involving collaboration with local shops or with organizational involvement of parents.
6. The strategy of the intervention includes clear involvement of members from the communityin the planning phase of the intervention or in the implementation phase. Involvement of community members (citizens/target population or stakeholders1 except local policy) in planning the intervention means that they participated in discussions, preferably indicated prevention of obesity as a priority topic because of a
1
With stakeholders we mean representatives from society partners, who are able to influence the intervention, demand results from the intervention, participate in or receive services from the intervention, or hold the intervention
perceived need and/or agreed on the contents of the intervention before actual implementation.
For an intervention to meet the criterion of community involvement in the implementation phase, at least one of the following options should apply:
a. Financial structure in which community individuals or groups can apply for budget to start and coordinate activities that are part of the
intervention, and/or;
b. Shared accountability of stakeholders1 with clear documented description of their responsibilities during implementation and/or;
c. Active involvement of stakeholders1 and/or clear intention of the
intervention to stimulate new social networks to achieve less obesogenic influences.
7. The CBI approach should have a monitoring/evaluation component, which at least should consist of a process evaluation (results do not need to be available yet). 8. We are kindly asking you to select the main and/or original CBIs targeting childhood
obesity in your country while neglecting all CBIs diverted from these interventions. So, it is only required to provide information for ORIGINAL CBIs. For example: if in your country one type of CBI (for example EPODE-like approaches) is supported from a national level and implemented in many regions it is necessary to complete the CBI- questionnaire only ONE time for this intervention).
ANNEX 2 –
Questions of short questionnaire (to be completed by key informants for each country)
1. For which country are you filling in this questionnaire?
2. Is reducing childhood obesity a priority in your national and/or regional public health policy?
0 Yes 0 No 0 Unknown
3 Which of the following options does best describe the situation in your country regarding CBIs against childhood obesity:
0 There is a central/national policy regarding CBIs targeting childhood obesity; local initiatives are in most cases derivations of a limited number of central/national examples.
0 There is no clear central/national policy on CBIs targeting childhood obesity, but (probably) many CBIs are implemented through local initiatives.
0 A combination of the above two options is the case (i.e. we have a central/national policy (involving ‘model CBIs’) and besides that also (probably) many initiatives at a local level are implemented, which are not clearly related to the CBIs that are supported as ‘model CBIs’ in the national policy).
0 There is no clear central/national policy on CBIs targeting childhood obesity, and not many CBIs are implemented through local initiatives either.
0 None of these options does adequately describe the situation in my country. → 3a 0 Unknown
3a →Could you please describe the policy situation in your country regarding
CBIs against childhood obesity? ………
4. In this question, we ask for contact details for CBI experts that will receive a questionnaire about characteristics for a specific CBI that in your opinion fulfills the inclusion criteria stated in the email you received.
Please note that we only ask for the original CBIs (so for example: for ‘EPODE’, the CBI-questionnaire needs to be completed only once and we consequently ask for only one contact person, even if EPODE like approaches are implemented at a large scale in your country).
Depending on the policy situation in your country (question 2) the possibility exists that you identified (too) many ‘original’ CBIs, despite the fact that the
inclusion criteria for this project are rather restrictive. In that case you are advised to make a selection; please consider which CBIs you would like to be added to the project/Commission database for best practice sharing and make a selection accordingly.
Name of CBI Name of contact person: e-mail address: --- --- --- Would you like to add another CBI and contact person?
0 Yes →
0 No
→ Name of CBI Name of contact person: e-mail address:
--- --- --- Would you like to add another CBI and contact person?
Etcetera
5. In the previous question you provided an overview of CBIs in your country that fulfill the inclusion criteria. The possibility exists that you made a selection in case the total number of original CBIs (fulfilling the inclusion criteria) is too large. Could you please estimate how many of all eligible original CBIs against childhood obesity have been selected?
0 Not applicable, as I did not make a selection; we will provide information on (almost) all original eligible CBIs in my country
0 I selected most of the CBIs in my country →
0 I selected about half of all CBIs in my country →
0 I selected only a small selection of all CBIs in my country →
0 I don’t know how many of all CBIs reducing childhood obesity I have selected →
5a. → In what way did you make the selection of identified CBIs? (Multiple answers possible)
0 I selected only the most important CBIs (implemented at a large scale) 0 I selected only well-known CBIs (that received a lot of media attention) 0 I selected only those CBIs for which information can be easily gathered 0 I selected only those CBIs that I am familiar with
0 I used another basis for selection →→
5a1 →→ What other basis did you use for selecting CBIs?
………
6. What search method did you use to identify the eligible CBIs implemented in your country? (Multiple answers possible)
0 National and/or regional registries/databases of preventive interventions in my country
0 International databases of preventive interventions (like the Trials Register of Promoting Health Interventions (TRoPHI), the Canadian Best Practices Portal or the European Directory of Good Practices to reduce health inequalities)
0 Consulting policy documents
0 Consulting the organization/institution that is responsible for implementation of these CBIs in my country
0 Consulting reports on preventive interventions in my country 0 Asking colleagues/other professionals to provide information 0 Other method(s) →
6a. → What other method(s)? 7. Do you have any additional remarks?
0 Yes →
0 No
ANNEX 3 –
Inventory of existing sources that were screened for potentially suitable CBIs
- Database of Promoting Health Effectiveness Reviews (DoPHER)
DoPHER contains details of a large amount of systematic and non-systematic reviews of effectiveness in health promotion and public health worldwide.
- OECD Health Working Papers No. 48: Improving lifestyles, tackling obesity: the health and economic impact of prevention strategies
- OECD report: Obesity and the Economics of Prevention
- Health-promoting schools: a resource for developing indicators (report of the International Planning Committee of the European Network of Health Promoting Schools)
- Review of previous and existing actions, initiatives, policies on nutrition and physical activity (report of the EURO-PREVOB project)
- Focusing on Obesity through a Health Equity Lens (report from EuroHealthNet) - Overview of good practices presented at the POIN-2010 conference as a result of the IMPALA project ; http://www.impala-eu.org/poin2010/en/speakers
- Overview of best practices collected by the PATHE project (accessible through
http://ec.europa.eu/eahc/projects/database.html: search for ‘isca pathe’: 6th link is the PATHE Handbook)
- The Guide to Community Preventive Services - WHO health evidence network (HEN)
- Final report of the EU-project: European Mapping of Obesity Best practice (EMOB) Trials Register of Promoting Health Interventions (TRoPHI)
TRoPHI contains randomized and non-randomized controlled trials of interventions in health promotion and public health. This database is hosted by the EPPI-Centre, which is part of the Social Science Research Unit at the Institute of Education in London. Since August 2004 a quarterly search of the literature provides input to this database. Contact address is [email protected].
A freetext search in this database using ‘obesity’ resulted in 306 hits. Using ‘childhood obesity’ 48 interventions were identified.
The Canadian Best Practices Portal
The Canadian Best Practices Portal is a compendium of community interventions related to chronic disease prevention and health promotion that have been evaluated, shown to be successful, and have the potential to be adapted and replicated by other health
practitioners working in similar fields. The portal was launched publicly in November 2006 and is a project of the Centre for Chronic Disease Prevention and Control (CCDPC) within the Public Health Agency of Canada (PHAC). The contact address is undisclosed, but questions may be asked through the ‘contact us’ button on the site.
Searching this database using the keyword ‘obesity’ resulted in 53 hits. Using ‘childhood obesity’ 8 interventions were identified.
European Directory of Good Practices to reduce health inequalities
This is a database containing good practices to reduce health inequalities and is part of DETERMINE – a EU consortium for Action on Socio-economic Determinants of Health. Searching this database using the keyword ‘obesity’ resulted in 8 hits. Using ‘childhood obesity’ no interventions were identified. However, reviewing the previous 8 results showed that children were among the target populations.
ANNEX 4 –
List of potentially suitable projects, country, method of identification, and response
Country Potentially suitable projects Method of
identification
Eligibility Response
1 X-team 1
2 KIG Kinder im Gleichgewicht 1
3 teen power 10/14 1 8
4 Durch Dick und Dünn 1
5 Rundum gsund 1 5
6 Down and up 1 7
Austria
7 In.Form 1
1 Fitte School 3,4
2 VIASANO (EPODE methodology) 3 X
3 Middle School Intervention 3